Objectives India contributes approximately 25% of the ‘missing’ cases of tuberculosis (TB) globally. Even though ~50% of patients with TB are diagnosed and treated within India’s private sector, few are notified to the public healthcare system. India’s TB notification policy mandates that all patients with TB are notified through Nikshay (TB notification portal). We undertook this study in a private hospital to assess the proportion notified and factors affecting TB notifications. We explored barriers and probable solutions to TB notification qualitatively from health provider’s perspective. Study setting Private, tertiary care, teaching hospital in Bengaluru, South India. Methodology This was a mixed-methods study. Quantitative component comprised a retrospective review of hospital records between 1 January 2015 and 31 December 2017 to determine TB notifications. The qualitative component comprised key informant interviews and focus groups to elicit the barriers and facilitators of TB notification. Results Of 3820 patients diagnosed and treated, 885 (23.2%) were notified. Notifications of sputum smear-positive patients were significantly more likely, while notifications of children were less likely. Qualitative analysis yielded themes reflecting the barriers to TB notification and their solutions. Themes related to barriers were: (1) basic diagnostic procedures and treatment promote notification; (2) misconceptions regarding notification and its process are common among healthcare providers; (3) despite a national notification system other factors have prevented notification of all patients; and (4) establishing hospital systems for notification will go a long way in improving notifications. Conclusions The proportion of patients with TB notified by the hospital was low. A comprehensive approach both by the hospital management and the national TB programme is necessary for improving notification. This includes improving awareness among healthcare providers about the requirement for TB notifications, establishing a single notification portal in hospital, digitally linking hospital records to Nikshay and designating one person to be responsible for notification.

Tyrosine kinase inhibitors (TKIs) are currently the first therapy option for chronic myeloid leukaemia (CML) and acute myeloid leukaemia (AML) patients. However, many patients affected by CML and AML may develop resistance to TKIs or may not recover under this treatment regime. New potential and more effective treatments are recently emerging. Heat shock protein inhibitors (HSPIs) and the proteasome inhibitor Bortezomib are drugs which have been yet to be successfully tested on leukemic patients, despite being successful on other malignancies such as multiple myeloma (MM). The combination between HSPIs and Bortezomib could potentially be successful in killing leukemic cells, by enhancing their respective molecular mechanisms. Indeed, HSPIs would bind to HSP72 avoiding the protein to exert its ligase function to the proteasome, whilst Bortezomib could stop the ubiquitinated proteins to enter the proteasome and ultimately inducing apoptosis. To test the effects of such combination, cell viability was measured via MTS assay, apoptosis levels were tested through Annexin V\PI assays. Involvement of HSP72 and pro-survival protein Bcl-2 were measured via flow-cytometry. The cells were administered with HSPIs and Bortezomib first as single agents for 24 hours, to establish working minimal concentration. Also, the drugs were tested for a shorter time, to understand when the drugs start to be effective. It emerged that one hour is sufficient for the drugs to give an initial effect in terms of cell viability and apoptosis. Following, combination experiments of HSPIs and Bortezomib were performed; the first drug was administered for one hour, the second following one hour and the cells were incubated for 24 hours. This was repeated alternatively for both type of drugs on the different cell lines. MTS and Annexin V\PI showed that there is not a synergistic effect between drugs, but instead there is antagonism. No necrosis was found at any level of the study. The cells were then probed for HSP72 and Bcl-2, to investigate their involvement in apoptosis mechanisms. Following 6 hours of combined and single agent treatment, both type of drugs inhibit HSP72 but failed to reduce the expression of Bcl-2, particularly on AML cells. It is thus proposed that CML and AML cells may die by apoptosis following a short time of treatment with HSPIs and Bortezomib by an extrinsic pathway of apoptosis, independent from Bcl-2 involvement and from mitochondrial pathway of apoptosis. This study may be the first to indicate a potential use of HSPIs and Bortezomib on CML and AML patients for a short time of treatment, although not in combination. Future studies are needed to further investigate the mechanisms of action of these drugs, aiming to potentially give CML and AML patients another successful therapy option to overcome resistance to canonic chemotherapy.

Background Police officers require a specific level of aerobic fitness to allow them to complete personal safety training and specialist roles. Officers’ aerobic fitness is assessed using the 15-m multi-stage fitness test (MSFT); however, due to the agility required and risk of injury, two alternative treadmill tests have been designed to predict four of the key minimum VO2 criteria of 35, 41, 46 and 51 ml·kg−1·min−1. Aims To investigate the validity and reliability of Chester Treadmill Police Walk Test (CTPWT) and Chester Treadmill Police Run Test (CTPRT). Methods Seventy-eight UK police officers (18 females) completed the CTPWT (n = 53) or CTPRT (n = 35), or both, generating a total of 88 data sets. To assess reliability, 43 participants returned for a second visit (T2), to repeat the treadmill test. Results Mean differences between predicted and actual VO2 at 35, 41, 46 and 51 ml·kg−1·min−1 were as follows
−1.1, −2.1, −0.1 and −1.2 ml·kg−1·min−1. Despite a significant under prediction (p = 0.001), a minimum of 92% of participants were within 10% of target VO2 at all levels. There was no significant difference between actual and predicted VO2 in the CTPRT, at 46 ml·kg−1·min−1 (T1 46.0 ± 1.4 or T2 45.1 ± 1.3 ml·kg−1·min−1). Similarly, there was no significant difference at 51 ml·kg−1·min−1 (T2 50.5 ± 1.4 ml·kg−1·min−1). We observed no differences for gender or trial. Ninety-five per cent limits of agreement were at worst T1–T2 −0.25 ± 4.0 ml·kg−1·min−1. Conclusions The CTPWT and the CTPRT provide a valid and reliable alternative to the 15-m MSFT.
Key words Exercise testing; fitness; fitness standards; occupational; police; predictive; treadmill test.

Purpose: To assess a standardised testing battery’s ability to differentiate anthropometric and physical qualities between youth, academy and senior rugby league players, and determine the discriminant validity of the battery.
Methods: A total of 729 rugby league players from multiple clubs within England categorised as youth (n = 235), academy (n = 362) and senior (n = 132) players completed a standardised testing battery that included the assessment of anthropometric and physical characteristics during preseason. Data was analysed using magnitude-based inferences and discriminant analysis.
Results: Academy players were most likely taller and heavier than youth players (effect size (ES) = 0.64 to 1.21), with possibly to most likely superior CMJ, medicine ball throw and prone Yo-Yo IR1 performance (ES = 0.23 to 1.00). Senior players were likely to most likely taller and heavier (ES = 0.32 to 1.84), with possibly to most likely superior 10 and 20 m sprint times, CMJ, CoD, medicine ball throw and prone Yo-Yo IR1 compared to youth and academy (ES = -0.60 to 2.06). The magnitude of difference appeared to be influenced by playing position. For the most part, the battery possessed discriminant validity with an accuracy of 72.2%.
Conclusion: The standardised testing battery differentiates anthropometric and physical qualities of youth, academy and senior players as a group and, in most instances, within positional groups. Furthermore, the battery is able to discriminate between playing standards with good accuracy and might be included in future assessments and rugby league talent identification.

Urbanisation exposes wildlife to new challenging conditions and environmental pressures. Somemammalian species have adapted to these novel environments, but it remains unclear which char-acteristics allow them to persist. To address this question, we identified 190 mammals regularlyrecorded in urban settlements worldwide, and used phylogenetic path analysis to test hypothesesregarding which behavioural, ecological and life history traits favour adaptation to urban environ-ments for different mammalian groups. Our results show that all urban mammals produce largerlitters; whereas other traits such as body size, behavioural plasticity and diet diversity were impor-tant for some but not all taxonomic groups. This variation highlights the idiosyncrasies of theurban adaptation process and likely reflects the diversity of ecological niches and roles mammalscan play. Our study contributes towards a better understanding of mammal association tohumans, which will ultimately allow the design of wildlife-friendly urban environments and con-tribute to mitigate human-wildlife conflicts.

This study describes pacing strategies adopted in an 86-km mass-participation cross-country marathon mountain bike race (the 'Birkebeinerrittet'). Absolute (km·h ) and relative speed (% average race speed) and speed coefficient of variation (%CV) in five race sections (15.1, 31.4, 52.3, 74.4 and 100% of total distance) were calculated for 8182 participants. Data were grouped and analysed according to race performance, age, sex and race experience. The highest average speed was observed in males (21.8 ± 3.7 km/h), 16-24 yr olds (23.0 ± 4.8 km/h) and those that had previously completed >4 Birkebeinerrittet races (22.5 ± 3.4 km/h). Independent of these factors, the fastest performers exhibited faster speeds across all race sections, whilst their relative speed was higher in early and late climbing sections (Cohen's d = 0.45-1.15) and slower in the final descending race section (d = 0.64-0.98). Similar trends were observed in the quicker age, sex and race experience groups, who tended to have a higher average speed in earlier race sections and a lower average speed during the final race section compared to slower groups. In all comparisons, faster groups also had a lower %CV for speed than slower groups (fastest %CV = 24.02%, slowest %CV = 32.03%), indicating a lower variation in speed across the race. Pacing in a cross-country mountain bike marathon is related to performance, age, sex and race experience. Better performance appears to be associated with higher relative speed during climbing sections, resulting in a more consistent overall race speed.

The importance of honey for medicinal purposes is well documented in some of the
world’s oldest literature. Honey is well known and studied for its antimicrobial properties. The
medicinal properties in honey originate from the floral source used by bees. Manuka honey is a dark
monofloral honey rich in phenolic content, and currently it is gaining much attention for its
antimicrobial activity. Researchers have found that honey is effective against a wide range of
pathogens. The antibacterial potency of Manuka honey was found to be related to the Unique
Manuka Factor (UMF) rating, which is correlated with the methylglyoxal and total phenols content.
It is reported that different types of Manuka honey have differing effects and Gram-negative bacteria
are more resistant than Gram-positive bacteria. Bacterial resistance to honey as antimicrobial agent
has yet to be identified, possibly due to the presence of a complex mixture of methylglyoxal and
other components. Honey is also reported to alter a bacterium’s shape and size through septal ring
alteration, which affects cell morphology and growth. Research has shown that Manuka honey of
different UMF values has medicinal properties of interest and it can be beneficial when used as a
combination treatment with other antimicrobial agents

In recent years one of the most commonly discussed issues in professional sport, and in particular Association Football, has been the pay of professional athletes. However, much of this literature is largely based on assumptions, speculation or broad financial reports, with little, if any, focus on the potential impact on the athletes’ lives. Therefore, the aim of this research was to examine the role money plays in the relationships within the working lives of professional footballers. Using professional football as a case study, this project examined a number of key areas: the consumption of products by footballers as a demonstration of economic power and wealth in an environment where wages are a taboo subject, the complex nature of contract negotiations and the impact this can have on relationships within their working lives. In addition to these areas, the thesis examined how money is used as punishment for players to try to encourage them to conform to the expected codes of behaviour set by club managers and officials, and ways in which players attempt to break their highly routinised daily life. Semi-structured interviews were conducted with 34 male professional footballers and analysed using concepts from the sociology of money. It is argued that image has become an important factor for many professional footballers. Displaying wealth through ‘conspicuous consumption’ was also important in an environment where wages are a secretive subject, as it is suggested that the ‘more you have, the better you are’ and therefore some players even felt that this would impact on the way in which they were valued by the club hierarchy (as well as their teammates within the club). Value was also important through contract negotiations, as the more a player was valued by a club, the greater balance of power they had within the negotiation process. It is argued the negotiation process has become more complex since the introduction of the Premier League, as more people are typically involved. It was also evident that money was a major factor for players when deciding on contracts or having to relocate, which led to feelings of loneliness for some players and their families. Players are heavily regulated and constrained within their lives, one-way players are constrained, by the club officials, is through financial punishment. Players discussed several methods of trying to break the routinisation that such constraints introduce. One of those was gambling. It is argued that some players, due to the technological advances, were able to gamble in a covert manner and keep their gambling losses private, which can impact on the performance, health and wellbeing of the players. Overall the results of this study highlight the increasing monetisation of social relationships within professional football and that such trends are significantly impacting on the relationships within the working lives of professional footballers.

Dancers frequently experience pain and injury due to the physical demands of performance. Previous research primarily focuses on professional dancers over the age of 18 years, and Irish dance has been largely unexplored, with research from a sociological perspective particularly lacking. To address these gaps, the purpose of this study was to explore the influence of the culture of Irish dance on young female dancers’ views and experiences of pain and injury. Data were generated through semi-structured interviews with eight girls (aged 11-16 years) from an Irish dance academy in the North West of England. We analysed the data by engaging in thematic analysis, and drew on Bourdieu’s concepts (habitus and capital, in particular) to explain our findings. Key themes within the data were: the values of Irish dance; trust and teamwork; and strength and weakness. The findings show that Irish dancers make sacrifices to achieve success, and the culture of Irish dance encourages them to dance through pain and injury in order to appear strong. While dancers recognise the potential consequences of injury and believe it is beneficial to take time away from training to recover, they are often encouraged (and encourage each other) to persevere through pain and injury. The findings suggest that there are some potentially harmful consequences of the Irish dance culture, as pain and injury are normalised. We suggest that coaches (and parents/guardians) should encourage young dancers to engage with self-care, and ensure they are not risking their future health and wellbeing by dancing through pain and injury.

The FitroDyne and GymAware rotary encoders are being increasingly used in resistance training to monitor movement velocity, but how closely their velocity outcomes agree is unknown. Consequently, this study aimed to determine the level of agreement between the FitroDyne and GymAware for the assessment of movement velocity in three resistance training exercises. Fifteen males performed three repetitions of bench press, back squat and bent-over-row exercises at 10% one repetition maximum increments (from 20 to 80%). For each repetition, the FitroDyne and GymAware recorded peak and mean barbell velocity (cm.s-1). Though strongly correlated (r = 0.79 to 1.00), peak velocity values for the GymAware were significantly lower than the FitroDyne for all exercises and loads. Importantly, the random errors between the devices, quantified via Bland and Altman's 95% limits of agreement, were unacceptable, ranging from ± 3.8 to 25.9 cm.s-1. Differences in mean velocity were smaller (and non-significant for most comparisons) and highly correlated (r = 0.86 to 1.00) between devices. Notwithstanding smaller random errors than for the peak values, mean values still reflected poor agreement (random errors between ± 2.1 to 12.0 cm.s-1). These findings suggest that the FitroDyne and GymAware cannot record peak or mean velocity with acceptable agreement, and should neither be employed interchangeably nor their data compared.

Fish stocking is a serious threat to originally fishless mountain lakes. We used non-chemical eradication methods (i.e. gillnetting and electrofishing) in four high mountain lakes in the Gran Paradiso National Park (Western Italian Alps) to eradicate alien brook trout Salvelinus fontinalis. Data of amphibians, macroinvertebrates, zooplankton, chlorophyll-a, nutrient concentrations, and water transparency were used as indicators of the recovery process. All treated lakes were returned to their original fishless condition in spite of their different sizes and habitat complexity, without permanent negative side-effects for native species. Several ecological indicators showed that many impacts of introduced fish can be reversed over a short time period following eradication. The present study adds to a still growing body of specialized literature on the recovery of habitats after the eradication of alien species and provides further evidence that physical eradication methods are effective and can be part of a more general strategy for the conservation of high mountain lake biota.

This thesis is composed of a series of papers, all of which have been published in peer reviewed publications. The papers use the recognised process of qualitative risk assessment in a range of scenarios in the field of wildlife health and welfare in both in situ and ex situ environments. Chapter 1 discusses the challenges faced regarding availability of empirical data in field of wildlife and zoological health and welfare and justifies the exploration of techniques to assist with decision making. The development of risk analysis and its integration with risk management and risk communication to become risk assessment is described before being put into the specific context of wildlife and zoological disease.
Chapters 2 and 3 consider two scenarios where disease risk assessment is well established as a tool, importation across national borders and in conservation interventions. Chapter 2 develops the standard import risk assessment approach to include multiple species and multiple diseases. Chapter 3 reviews developments made over the last 25 years and proposes best practice approaches to implement. Chapter 4 describes how the risk assessments formulated as described in Chapter 3 are used for licensing purposes emphasising the importance of risk management and communication. This theme is continued in Chapter 6 where the integration of risk assessment and evidence based decision making is considered in the broad context of a strategic approach to wildlife health bringing together the outcomes and processes described in Chapters 2, 3, 4 and 5.
The papers in Chapters 2,5 and 8 are focused on how risk analysis aids in development of disease control approaches and policy. The evidence base is composed primarily of peer-reviewed literature supported by expert review of the finalised assessment. Chapter 7 uses risk assessment in an applied scenario, taking the recognised process and modifying it to structure an active disease investigation demonstrating the versatility of the technique. Chapter 9 takes this a step further by again adapting the methodology which, has historically been used primarily for infectious diseases, to consider reproduction and assess risks to welfare rather than purely health. The paper in Chapter 9 builds on the methodology by combining existing peer-reviewed literature with data collected specifically for the purpose of feeding into the assessment and utilising a stakeholder and expert opinion elicitation workshop to obtain data too. These process are proposed and described in Chapter 3.
The final chapter critically reviews risk assessment, highlighting three key areas of potential weakness and proposing approaches to address these criticisms. The value of the approach in wildlife and zoological health and welfare as demonstrated by this series of papers is described

Land-use change and habitat loss are important drivers of biodiversity decline at both global and local scales. To protect species from the impacts of land-use change it is important to understand the population dynamics and habitat associations across these scales. Here we present an investigation into the survival and habitat preferences of Leucorrhinia dubia at the local scale at Fenn’s and Whixall Moss, Shropshire, UK. We used mark-release-recapture methods to investigate survival and used sightings of individual dragonflies along with habitat data to investigate habitat preference. We found that survival between capture-visits was very low and that L. dubia showed a clear preference for the open moss habitat on this site. In both cases, we found that the detectability, either through sightings or recaptures, was potentially very low and suggest that this should be taken into account in future analyses. We suggest that by encouraging recorders to submit complete lists and to repeat visits to sites detectability could be easily estimated for dragonfly species and incorporating this into analyses would improve estimates fo population trends and habitat associations.

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